Project Summary/Abstract The exchange of patient information between different healthcare organizations and can help improve the coordination, cost and quality of patient care. Improving provider access to patient information is a critical aspect of both federal and state healthcare policy. A common feature of health information exchange efforts (HIEs) across the U.S. is operation within a specific geographical area (e.g. a city, region or state). We don't actually know the extent of HIE coverage across the country, meaning individuals may be included in more than one effort or providers may have no local exchange in which to participate. This raises the questions of 1) how to define HIE exchange service areas and 2) what are implications of HIEs' actual exchange service areas on patient health, practice, policy and evaluation? This proposal seeks to establish and clarify the concept of geography that is a fundamental component of HIE activity and explore the practical and policy implications of how exchange service areas are defined through three aims. The first is to use geographic information systems (GIS) analyses to determine and compare the extent of health information exchange activity as defined by HIE themselves and by the healthcare markets of member organizations. In addition, through GIS this proposal aims to merge multiple healthcare related datasets to create new measures to help evaluate HIE efforts. Lastly, through qualitative GIS techniques, this project proposes to interview representatives of HIEs, participating healthcare organizations and non-participating healthcare organizations about the role of geography and cooperation in the effectiveness of HIE functionality and the effect on patient health. This proposal addresses the AHRQ research area of health information technology to support patient-centered care, the coordination of care across transitions in care settings, and the use of electronic exchange of health information to improve quality of care.